Exploring the long-term course of psychosis Understanding longitudinal changes and interrelationships between recovery domains in different phases of psychotic disorders

Psychotic disorders are disruptive on multiple aspects of life. In this doctoral thesis I evaluated longitudinal changes in patients with psychotic disorders on the following recovery domains: social functioning, symptoms, personal recovery or quality of life and cognition.
In part 1 I investigated longitudinal changes in the four recovery domains separately through meta-analyses that included studies evaluating longitudinal changes in patients with psychotic disorders over a follow-up period of at least 1 year. The influence of the patients’ duration of illness and other personal, clinical and social patient characteristics on these longitudinal changes were also evaluated. In part 2 I investigated to what extent changes in one recovery domain was associated with changes in another recovery domain through both a meta-analysis and through a longitudinal cohort study.
Overall, results indicated that people with psychotic disorders improve substantially over time in symptoms and social functioning, especially for patients with early psychosis, but cognition and personal recovery showed modest or no improvement over time. Improvement in social functioning, symptoms and cognition were associated with one another, indicating that longitudinal changes in these recovery domains might reinforce each other. Changes in personal recovery were hardly associated with changes in other recovery domains. This suggests that improvements in social functioning and symptoms did not translate into a more positive subjective experience of overcoming mental illness.
This thesis taught us that improvement in time in patients with psychotic disorders is possible, but special attention is needed for long-term improvement in cognition and personal recovery.